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BackgroundInfection with Human Papillomavirus (HPV) is a necessary event in the multi-step process of cervical carcinogenesis. Little is known about the natural history of HPV infection among unscreened young adults. As prophylactic vaccines are being developed to prevent specifically HPV 16 and 18 infections, shifts in prevalence in the post vaccine era may be expected. This study provides a unique opportunity to gather baseline data before changes by nationwide vaccination occur.Methods and Principal FindingsThis cross-sectional study is part of a large prospective epidemiologic study performed among 2065 unscreened women aged 18 to 29 years. Women returned a self-collected cervico-vaginal specimen and filled out a questionnaire. All HPV DNA-positive samples (by SPF10 DEIA) were genotyped using the INNO-LiPA HPV genotyping assay. HPV point prevalence in this sample was 19%. Low and high risk HPV prevalence was 9.1% and 11.8%, respectively. A single HPV-type was detected in 14.9% of all women, while multiple types were found in 4.1%. HPV-types 16 (2.8%) and 18 (1.4%) were found concomitantly in only 3 women (0.1%). There was an increase in HPV prevalence till 22 years. Multivariate analysis showed that number of lifetime sexual partners was the most powerful predictor of HPV positivity, followed by type of relationship, frequency of sexual contact, age, and number of sexual partners over the past 6 months.Conclusions and SignificanceThis study shows that factors independently associated with HPV prevalence are mainly related to sexual behaviour. Combination of these results with the relative low prevalence of HPV 16 and/or 18 may be promising for expanding the future target group for catch up vaccination. Furthermore, these results provide a basis for research on possible future shifts in HPV genotype prevalence, and enable a better estimate of the effect of HPV 16-18 vaccination on cervical cancer incidence.

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Human papillomavirus (HPV) is a necessary factor in the development of cervical intraepithelial neoplasia and cervical cancer. However, HPV is also a very common sexually transmitted virus and many women clear their infection. To study HPV incidence and clearance, 2,065 women, aged 18-29 years, were followed for 12 months and were asked to provide a self-collected cervicovaginal sample and fill-out a questionnaire every 3 months. For HPV DNA detection, the SPF 10 -DEIA LiPA 25 system was used. Incidence rates of any-type high-risk HPV and low-risk HPV were 17.0 per 1,000-person months, and 14.3 per 1,000-person months, respectively. HPV types 16, 52, 51 and 31 had the highest type-specific incidence rates. HPV incidence was increased in singles, and women having a new relationship. A higher number of lifetime sex partners, and a higher frequency of sexual contacts in the past 3 months was associated with an increased HPV incidence. The overall clearance of the newly detected typespecific high-risk HPV infections and low-risk HPV infections was 61.2% and 69.0%, respectively. Having a sexual relationship compared to being single, and a higher sexual age both positively influenced the clearance of any-type high-risk HPV. Among the women infected with HPV 16, the women who had a co-infection had a lower proportion of clearance of HPV 16. In conclusion, in this young Dutch study population, HPV incidence rates are not related to age and comparable to other western countries. Clearance was only independently related to factors associated with sexual behavior, either past or current.It is generally accepted that a persistent human papillomavirus (HPV) infection is the necessary cause of cervical cancer. Acquisition of an HPV infection is therefore the main precursor of the series of events that eventually lead to cervical cancer.1-4 Fortunately, most of the acquired HPV infections are transient and clear spontaneously within 12 months after first detection, and about 90% of the women will have cleared their HPV infection within 24 months. [5][6][7][8][9][10][11][12][13] HPV is a very common sexually transmitted virus, mainly acquired early in sexual life.14,15 Rates of acquiring an HPV infection are high following first sexual intercourse, and with each new sexual partner. 7,16,17 The risk factors associated with acquiring an HPV infection are therefore mainly related to the individuals sexual behavior. 18HPV prevalence, however, is not only influenced by sexual activity but also varies by age and geography, as shown by the International Agency for Research on Cancer (IARC) and others. [19][20][21] Young women have high rates of HPV acquisition, and incidence tends to decline with age. 10,17,22,23 Whether age is also related to the duration of the infection remains controversial. Some studies report that there is no influence of age on the clearance rate of the HPV infection. 10,24,25 Whereas other studies report a lower clearance rate with increasing age, 26,27 or in contrary a faster clearance rate in older women (>4...